State Fair Hearings

If you do not agree with your plan's decision on your appeal, you can ask for a State Fair Hearing. In North Carolina, State Fair Hearings include an offer of a free and voluntary mediation session. This meeting is held before your State Fair Hearing date.

Free and voluntary mediations

When you ask for a State Fair Hearing, you will get a phone call from The Mediation Network of North Carolina. The Mediation Network will call you within five business days after you request a State Fair Hearing. The state offers this free meeting to help resolve your disagreement quickly. These meetings are held by phone.

You do not have to accept this meeting. You can ask to schedule just your State Fair Hearing. When you do accept, a Mediation Network counselor will lead your meeting. This person does not take sides. A member of your plan’s review team will also attend. If the meeting does not help with your disagreement, you will have a State Fair Hearing.

State Fair Hearings process

State Fair Hearings are held by the North Carolina Office of Administrative Hearings (OAH). An administrative law judge will give you a decision. You can give any updates and facts you need to at this hearing. A member of AmeriHealth Caritas North Carolina's review team will attend. You may ask questions about AmeriHealth Caritas North Carolina's decision. The judge in your State Fair Hearing is not a part of your health plan in any way.

It is easy to ask for a State Fair Hearing. Use one of the options below:

  • Mail: Fill out and sign the State Fair Hearing Request Form that comes with your notice.
  • Fax: Fill out, sign and fax the State Fair Hearing Request Form that comes with your notice.
  • By phone: There are instructions in your letter that will tell you who to call. You will get help with your form during this call.
  • Online: There are instructions in your letter that will tell you how to request a State Fair Hearing online.

For assistance with requesting a State Fair Hearing, please contact Member Services at 1-855-375-8811 (TTY 1-866-209-6421). You can call 24 hours a day, seven days a week.

If you are unhappy with your State Fair Hearing decision, you can appeal to the North Carolina Superior Court.

State Fair Hearings for disenrollment decisions

You can also ask for a State Fair Hearing for decisions that you disagree with about changing your health plan.

You, or your authorized representative, may ask for a State Fair Hearing if you disagree with a decision to:

  • Deny your request to change plans; or
  • Approve a request we made for you to leave the plan

You can ask for a State Fair Hearing within 30 days from the day you receive a notice informing you of the decision about your request to change plans or our request for you to leave the health plan.

You can use one of the following ways to request a State Fair Hearing:

  • Mail: Fill out and sign the State Fair Hearing Request Form that comes with your notice.
  • Fax: Fill out, sign and fax the State Fair Hearing Request Form that comes with your notice.
  • By phone: There are instructions in your letter that will tell you who to call. You will get help with your form during this call.
  • Online: There are instructions in your letter that will tell you how to request a State Fair Hearing online.
Members